幕上高血压脑出血患者神经内镜微创手术与开颅手术的疗效对比研究  

Comparative study of neuroendoscopic minimally invasive surgery and craniotomy for supratentorial hypertensive cerebral hemorrhage

作　　者：肖涛[1] 万娟 蒋文武[1] Xiao Tao;Wan Juan;Jiang Wenwu(Department of Neurosurgery,the First Affiliated Hospital of University of South China,Hengyang,Hunan 421001,China)

机构地区：[1]南华大学附属第一医院神经外科,湖南省衡阳市421001 [2]南华大学附属第一医院神经内科,湖南省衡阳市421001

出　　处：《中国脑血管病杂志》2019年第9期456-460,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：湖南省自然科学基金青年基金项目(2019JJ50540)

摘　　要：目的对比分析幕上高血压脑出血患者采用神经内镜微创手术及开颅手术的安全性和疗效。方法回顾性连续纳入2016年6月至2018年4月南华大学附属第一医院神经外科收治的高血压脑出血患者85例,发病至手术时间3~36 h,平均(14±7) h;均为幕上脑出血,其中基底节区脑出血42例,丘脑出血28例,皮质出血15例;出血位于左侧44例,右侧41例;破入脑室38例;出血量32~82 ml,平均(52±11) ml;术前格拉斯哥昏迷量表(GCS)评分6~12分,平均(8. 2±1. 5)分。根据治疗方式的不同,将85例患者分为开颅手术组(51例)和内镜治疗组(34例)。记录并对比分析两组患者的基线资料(性别、年龄、高血压病史、出血量、出血部位)、手术及其相关并发症情况(血肿清除率、手术时间、术后再出血率、颅内感染率)。对两组患者术后3个月预后进行评价,以格拉斯哥预后量表评分4~5分为预后良好,以1~3分为预后不良。结果(1)两组患者男性、高血压病史、年龄、术前GCS评分、出血量和出血部位的差异均无统计学意义(均P> 0. 05)。(2)内镜治疗组血肿清除率高于开颅手术组[(86. 7±2. 2)%比(70. 4±7. 2)%,t=9. 135],手术时间少于开颅手术组[(72±6) min比(149±21) min,t=-20. 340],组间差异均有统计学意义(均P <0. 01);两组患者术后再出血率及颅内感染发生率的差异均无统计学意义(均P> 0. 05)。(3)内镜治疗组预后良好率高于开颅手术组,组间差异有统计学意义[82. 4%(28/34)比60. 8%(31/51),χ2=4. 470,P=0. 034]。结论对于治疗幕上自发性脑出血患者的安全和疗效,与开颅手术相比,神经内镜微创手术下血肿清除是一种可供选择的手术方法。Objective To investigate and compare the safety and efficacy of neuroendoscopic minimally invasive surgery and craniotomy for supratentorial hypertensive cerebral hemorrhage. Methods From June 2016 to April 2018,85 patients with hypertensive intracerebral hemorrhage treated in Department of Neurosurgery,the First Affiliated Hospital of University of South China were recruited.The time from onset to operation was 3 - 36 h,averaging 14±7 h.All cases were supratentorial cerebral hemorrhage,including 42 cases of basal ganglia cerebral hemorrhage,28 cases of thalamic hemorrhage and 15 cases of cortical hemorrhage. 44 cases of hemorrhage were on the left side and 41 cases on the right side;38 cases of hemorrhage ruptured into ventricle.The blood loss ranged 32 - 82 ml,with an average of 52±11 ml.Preoperative Glasgow coma scale(GCS) scores ranged from 6 to 12 points,with an average of 8.2±1.5 points.According to different treatment methods,85 patients were divided into two groups:the craniotomy group( n =51) and the endoscopic treatment group( n =34).Baseline data,operation condition and related complications were recorded and compared between the two groups.The prognosis of the two groups was evaluated three months after the operation.The Glasgow prognostic scale score 4 - 5 was defined as favorable prognosis,and score 1 - 3 as unfavorable prognosis. Results (1) There were no statistically significant differences in male gender,history of hypertension,age,preoperative GCS score,blood loss and bleeding site between the two groups(all P >0.05).(2) The clearance rate of hematoma in the endoscopic treatment group was higher than that in the craniotomy group([86.7±2.2]% vs.[70.4±7.2]%, t = 9.135),and the operation duration was shorter than that in the craniotomy group([72±6] mins vs .[149±21] mins, t =-20.340).All the differences were statistically significant(all P <0.01).There were no statistically significant differences in postoperative bleeding rate and intracranial infection rate between the two groups(all P> 0

关 键 词：颅内出血 高血压性 外科手术 微创性 内镜手术 颅骨切开术 疗效比较研究 

分 类 号：R651.1[医药卫生—外科学]